DEA expression for technical efficiency (TE)

1. DEA expression for technical efficiency (TE) Max Subject to for j=1,…, n, ur, vi≥ 0 for all i and r

2. DEA framework with one input andone output E Number of treated patients D C • A, B, C, D, and E are efficient decision making units on the production frontier • F is inefficient and below the frontier • Efficiency score for input-oriented model equals to d1/d2 • Efficiency score for output-oriented model equals to d3/d4 B d1 F A d2 d4 d3 Total spending on ART

3. Means of inputs by year Mean HIV/AIDS spending by year Obs denotes number of observations

4. Means of outputs by year Mean coverage of VCT, PMTCT and ARV treatment 4

5. DEA models by year • Average efficiency: 49.75%

6. Performance for 45 countries in 2006 Note: One output unit is one patient on ARV or equivalent for one year

7. Unit cost of national programs by output

8. Cautions with interpretation • Unconditional efficiency scores may not perfectly match experts’ perception • DEA does not account for measurement errors • For countries that achieved 100% efficiency, the result does not mean that their efficiency cannot be improved in the future

9. Pooled DEA model by year

10. Component II: Determinants of efficiency of national HIV/AIDS programs • Objective: • To indentify social and economic determinants of efficient HIV/AIDS programs • Methods: Random-effects Tobit model • Model: • Dependent variable: log of efficiency • Independent variables • Governance • Political support • Financing mechanism • Economic and demographic characteristics • t denotes time and i denotes country

11. Regression on log efficiency(Random-effects Tobit model)

12. Conclusions 1 • Substantial scope for improving HIV/AIDS programs • Output-oriented DEA: If countries performed optimally, given the resources available, outputs would double • Input-oriented DEA: If countries performed optimally, they would require half of the previous resources to achieve the previous level of services

13. Conclusions 2 • Dollars matter, so does the efficiency of using dollars

15. Conclusions 3 • Addressing countries’ harsh environment is helpful in controlling HIV/AIDS • if countries achieved a notable* increase in “voice and accountability,” the efficiency of their HIV/AIDS programs would increase by 40.8%. • For countries in the lowest quartile of per capita gross national income (GNI), a notable* increase in GNI would increase the efficiency of their AIDS programs by 45.0%. *A “notable” increase is defined as change from the lowest 25th percentile to the average value of a variable

16. Conclusions 4 • Low-income countries with high HIV/AIDS prevalence remain the targets for controlling the spread of HIV/AIDS • Low income countries share most of HIV/AIDS burden • Low level of governance in those countries implies significant room for improvement of efficiency

17. Relationship between gross national income and government effectiveness

18. Conclusion 5 • Controlling HIV/AIDS requires health sector actions beyond HIV/AIDS • Increase government commitment to health • Strengthen health care system

19. Conclusion 6 • Controlling HIV/AIDS requires multisectoral cooperation beyond the health sector • Strengthen governance • Alleviate poverty 19

20. Limitations • DEA highly sensitive to data accuracy • Input and outputs assumed representative • Quality of services not measured • Lag effect of inputs not considered

21. Acknowledgements • Joan Kaufman, ScD, Brandeis University • John Stover, Futures Institute 21

22. Thank you! Contact: Shepard@brandeis.edu Wuzengcn@brandeis.edu